Pain mechanisms: A new theory: A gate control system modulates sensory input from the skin before it evokes pain perception and response

Abstract

Abstract A gate control system modulates sensory input from the skin before it evokes pain perception and response. The nature of pain has been the subject of bitter controversy since the turn of the century ( 1 ). There are currently two opposing theories of pain: (i) specificity theory, which holds that pain is a specific modality like vision or hearing, “with its own central and peripheral apparatus” ( 2 ), and (ii) pattern theory, which maintains that the nerve impulse pattern for pain is produced by intense stimulation of nonspecific receptors since “there are no specific fibers and no specific endings” ( 3 ). Both theories derive from earlier concepts proposed by von Frey ( 4 ) and Goldscheider ( 5 ) in 1894, and historically they are held to be mutually exclusive. Since it is our purpose here to propose a new theory of pain mechanisms, we shall state explicitly at the outset where we agree and disagree with specificity and pattern theories. Specificity theory Specificity theory proposes that a mosaic of specific pain receptors in body tissue projects to a pain center in the brain. It maintains that free nerve endings are pain receptors ( 4 ) and generate pain impulses that are carried by A-delta and C fibers in peripheral nerves ( 6 ) and by the lateral spinothalamic tract in the spinal cord ( 2 ) to a pain center in the thalamus ( 7 ). Despite its apparent simplicity, the theory contains an explicit statement of physiological specialization and an implicit psychological assumption ( 8, 9 ). Consider the proposition that the skin contains “pain receptors.” To say that a receptor responds only to intense, noxious stimulation of the skin is a physiological statement of fact; it says that the receptor is specialized to respond to a particular kind of stimulus. To call a receptor a “pain receptor,” however, is a psychological assumption: it implies a direct connection from the receptor to a brain center where pain is felt (Fig. 1), so that stimulation of the receptor must always elicit pain and only the sensation of pain. This distinction between physiological specialization and psychological assumption also applies to peripheral fibers and central projection systems ( 9 ).